Provider Demographics
NPI:1437172111
Name:BROOKS, IRA MARK (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:MARK
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2810
Mailing Address - Country:US
Mailing Address - Phone:201-437-4073
Mailing Address - Fax:201-437-1050
Practice Address - Street 1:807 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2810
Practice Address - Country:US
Practice Address - Phone:201-437-4073
Practice Address - Fax:201-437-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04499300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBR451527Medicare ID - Type Unspecified